Personalized Medicine for PAD: Bridging Culture, Biology, and Technology

A physician once described a patient to me whose case captures the complexity of Peripheral Artery Disease (PAD). The man was in his early fifties, originally from South Asia, and had been experiencing pain in his legs while walking. On paper he did not fit the standard profile. His body mass index was relatively low, and he had no obvious family history of cardiovascular disease. Yet tests showed significant arterial narrowing. When the doctor looked more closely, the picture became clearer. His arteries were smaller in diameter, his diet had been heavy in refined carbohydrates since childhood, and physical activity had gradually declined after years of working long hours in an urban setting. What seemed at first like an unexpected case of PAD was, in reality, the result of biology shaped by culture and tradition.

PAD is often explained as the narrowing of arteries that supply blood to the limbs. But it is more than that. It is a condition influenced by genetics, anatomy, diet, lifestyle, and social history. PAD increases the risk of stroke, heart attack, and amputation, but it does not present the same way in every community. Behind each diagnosis lies an interaction between biology and culture.

In South Asian patients, PAD frequently develops earlier and at lower body mass indices. The biology of smaller vessel diameters and diffuse disease combines with cultural patterns of diet and reduced physical activity to accelerate disease progression. African American patients often face more severe outcomes, such as higher rates of restenosis and amputation. Biology plays a role through stronger inflammatory responses and reduced nitric oxide availability, but this is compounded by barriers to preventive care, dietary history, and systemic inequities in healthcare access.

In Hispanic and Indigenous groups, PAD often connects to the high prevalence of diabetes. The biological effects of diabetes include endothelial dysfunction and accelerated arterial stiffness, but cultural traditions around food preparation, limited access to fresh produce, and intergenerational dietary habits amplify the risk. Women face yet another layer of difference. Their smaller arteries and distinct drug metabolism pathways create biological challenges, but cultural expectations such as delaying care to prioritize family or underreporting symptoms influence outcomes just as strongly.

These differences underscore why personalized medicine is essential. A single treatment model cannot address the wide variation in patient biology and culture. Antiplatelet agents and statins remain central to pharmacotherapy, but genetic differences affect how patients metabolize these drugs. Angioplasty and stenting often restore circulation, yet patients with smaller arteries or greater calcification experience higher rates of restenosis. Drug-coated balloons, which deliver antiproliferative drugs directly to the vessel wall, offer an important alternative, but outcomes vary depending on how drugs interact with tissue and how patients engage with follow-up care.

My own research is focused on advancing this conversation. I am writing a review paper on personalized medicine in PAD, with an emphasis on how therapies such as pharmacotherapy, stents, and drug-coated balloons can be adapted to reflect both biological and cultural variation. Alongside this academic work, I conduct wet lab research in the Filgueira Lab, where I study new drug-coated balloon technologies. My work examines coating methods, drug-release kinetics, and vessel-wall responses, with the goal of creating devices that better align with the biology of diverse patient populations.

PAD is universal, but patients are not. A South Asian man with early-onset disease, an African American woman facing amputation risk, and an Indigenous patient with long-standing diabetes do not share identical stories. Their biology and culture intertwine to create unique expressions of the same condition. Personalized medicine, supported by innovations such as drug-coated balloons, offers a way forward. It allows differences to guide treatment rather than stand in the way of it. Only by honoring both biology and culture can medicine truly meet patients where they are.